Healthcare Provider Details

I. General information

NPI: 1477464535
Provider Name (Legal Business Name): TIANI JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MARIETTA HWY
CANTON GA
30114-2327
US

IV. Provider business mailing address

6044 GOLDEN LNDG
CANTON GA
30114-8963
US

V. Phone/Fax

Practice location:
  • Phone: 770-345-9535
  • Fax:
Mailing address:
  • Phone: 678-977-9751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: